Adrenocortical Agents

Adrenocortical agents are drugs used as short-term treatment to suppress immune system in patients with inflammatory disorders. They are also used for replacement therapy to maintain hormone levels when adrenal glands are not functioning adequately. These agents are classified into three: glucocorticoids, mineralocorticoids, and androgens.

Table of Common Drugs and Generic Names

Here is a table of commonly encountered adrenocortical agents, their generic names, and brand names:

Classification

Generic Name

Brand Name

Glucocorticoids

beclomethasone

Beclovent

betamethasone

Celestone

budesonide

Rhinocort, Entocort EC

dexamethasone

Decadron

hydrocortisone

Cortef

methylprednisolone

Medrol

prednisolone

Delta-Cortef

Mineralocorticoids

fludrocortisone

Florinef

hydrocortisone

Cortef

Disease Spotlight: Adrenal Insufficiency and Crisis

Adrenal insufficiency is a condition when patients experience a shortage of adrenocortical hormones and develop signs and symptoms like confusion, hyperpigmentation, hypoglycemia, and poor response to stress. This can occur when a patient does not produce enough ACTH, when the glands are not able to respond to ACTH, when an adrenal gland is damaged and cannot produce enough hormones (Addison’s disease), or secondary to surgical removal of glands. A prolonged use of corticosteroid hormones is a more common cause of adrenal insufficiency.

Adrenal crisis occurs when patients who have an adrenal insufficiency experience a period of extreme stress like vehicle accidents, massive infections, or a surgical procedure. The body is not able to supplement the energy-consuming effects of the sympathetic reaction. This is characterized by physiological exhaustion, hypotension, fluid shift, shock, and even death.

Patients in adrenal crisis are treated with massive infusion of replacement steroids, constant monitoring, and life support procedures.

Glucocorticoids

Definition

Glucocorticoids are agents that stimulate an increase in glucose levels for energy. They also increase the rate of protein breakdown and decrease the rate of protein formation from amino acids to preserve energy. They are also capable of lipogenesis, or the formation and storage of fat in the body for energy source.

Therapeutic Action

The desired and beneficial action of glucocorticoids:

bind to cytoplasmic receptors of target cells to form complex reactions needed to reduce inflammation and to suppress immune system.

Other glucocorticoids like hydrocortisone, cortisone, and prednisone also have mineralocorticoid activity so they can affect potassium, sodium, and water levels. They can also limit the activity of lymphocytes to act within the immune system. Furthermore, they inhibit the spread of phagocytes to the bloodstream and injured tissues.

Indications

Glucocorticoids are indicated for the following medical conditions:

short-term treatment of inflammatory disorders by blocking the actions of arachidonic acid leading to decrease in formation of prostaglandins and leukotrienes.

Local agents are used to treat local inflammation.

Systemic use is indicated for treatment of some cancers, hypercalcemia associated with cancer, hematological disorders, and some neurological infections.

When combined with mineralocorticoids, some of these drugs can be used in replacement therapy for adrenal insufficiency.

Pharmacokinetics

Here are the characteristic interactions of glucocorticoids and the body in terms of absorption, distribution, metabolism, and excretion:

Glucocorticoids are agents that stimulate an increase in glucose levels for energy. They also increase the rate of protein breakdown and decrease the rate of protein formation from amino acids to preserve energy. They are also capable of lipogenesis, or the formation and storage of fat in the body for energy source.

Question 2

Glucocorticoids can reduce inflammation and suppress the immune system by:

A

forming complex reactions needed to reduce inflammation

B

activating more lymphocytes to reduce inflammation

C

inhibiting the localization of phagocytes so immune system can rest

D

all of the above

Question 2 Explanation:

They bind to cytoplasmic receptors of target cells to form complex reactions needed to reduce inflammation and suppress the immune system. They also limit the activity of lymphocytes to act within the immune system. Lastly, they inhibit the spread of phagocytes to the bloodstream and injured tissues.

Question 3

A patient on aldosterone can eat all of the following meals, except:

A

egg-and-vegetable breakfast crostini

B

bagels, salad, and cottage cheese

C

dried peas and beans

D

white bean and roasted red bell pepper hummus

Question 3 Explanation:

All of the following are low in sodium except bagels, salad (dressing is high in sodium), and cottage cheese. High-sodium intake should be avoided to prevent severe hypernatremia.

Question 4

A patient is started on a regimen of prednisone because of a crisis in her ulcerative colitis. Nursing care of this patient would need to include:

A

immunizations to prevent infections

B

increased calories to deal with metabolic changes

C

fluid restriction to decrease water retention

D

administration of the drug around 8 or 9 AM to mimic normal diurnal rhythm.

Which of the following patient complaint(s) will alert the nurse for possible aldosterone toxicity?

A

muscle weakness and abdominal fullness

B

BP of 80/60 mmHg

C

parched skin and dry mucous membranes

D

all of the above

Question 5 Explanation:

Signs of toxicity include hypokalemia, weight gain, edema, and hypertension. Muscle weakness and abdominal fullness can be signs and symptoms of hypokalemia.

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Practice Quiz: Adrenocortical Agents

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Glucocorticoids are agents that stimulate an increase in glucose levels for energy. They also increase the rate of protein breakdown and decrease the rate of protein formation from amino acids to preserve energy. They are also capable of lipogenesis, or the formation and storage of fat in the body for energy source.

Question 2

Glucocorticoids can reduce inflammation and suppress the immune system by:

A

forming complex reactions needed to reduce inflammation

B

activating more lymphocytes to reduce inflammation

C

inhibiting the localization of phagocytes so immune system can rest

D

all of the above

Question 2 Explanation:

They bind to cytoplasmic receptors of target cells to form complex reactions needed to reduce inflammation and suppress the immune system. They also limit the activity of lymphocytes to act within the immune system. Lastly, they inhibit the spread of phagocytes to the bloodstream and injured tissues.

Question 3

A patient on aldosterone can eat all of the following meals, except:

A

egg-and-vegetable breakfast crostini

B

bagels, salad, and cottage cheese

C

dried peas and beans

D

white bean and roasted red bell pepper hummus

Question 3 Explanation:

All of the following are low in sodium except bagels, salad (dressing is high in sodium), and cottage cheese. High-sodium intake should be avoided to prevent severe hypernatremia.

Question 4

A patient is started on a regimen of prednisone because of a crisis in her ulcerative colitis. Nursing care of this patient would need to include:

A

immunizations to prevent infections

B

increased calories to deal with metabolic changes

C

fluid restriction to decrease water retention

D

administration of the drug around 8 or 9 AM to mimic normal diurnal rhythm.

Which of the following patient complaint(s) will alert the nurse for possible aldosterone toxicity?

A

muscle weakness and abdominal fullness

B

BP of 80/60 mmHg

C

parched skin and dry mucous membranes

D

all of the above

Question 5 Explanation:

Signs of toxicity include hypokalemia, weight gain, edema, and hypertension. Muscle weakness and abdominal fullness can be signs and symptoms of hypokalemia.

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1. Glucocorticoids are hormones that:

A. are released in response to high glucose levels
B. help to regulate water balance in the body
C. help to regulate electrolyte levels
D. promote the preservation of energy through increased glucose levels, protein breakdown, and fat formation

Glucocorticoids are agents that stimulate an increase in glucose levels for energy. They also increase the rate of protein breakdown and decrease the rate of protein formation from amino acids to preserve energy. They are also capable of lipogenesis, or the formation and storage of fat in the body for energy source.

2. Glucocorticoids can reduce inflammation and suppress theimmune system by:

A. forming complex reactions needed to reduce inflammation
B. activating more lymphocytes to reduce inflammation
C. inhibiting the localization of phagocytes so immune system can rest
D. all of the above

2. Answer: A. forming complex reactions needed to reduce inflammation

They bind to cytoplasmic receptors of target cells to form complex reactions needed to reduce inflammation and suppress the immune system. They also limit the activity of lymphocytes to act within the immune system. Lastly, they inhibit the spread of phagocytes to the bloodstream and injured tissues.

3. A patient on aldosterone can eat all of the following meals, except:

Therapeutic Action

Not all of them are used as pharmacological agents. Some are used for diagnostic purposes only and others are primarily used as antineoplastic agents.

Tesamorelin is used to stimulate GH and its lipolytic effects, helping to decrease the excess abdominal fat in HIV-infected patients with lipodystrophy.

Indications

Hypothalamic agents are indicated for the following medical conditions:

Hypothalamic hormones are not all available for pharmacological use; those that are available are used mostly for diagnostic testing, for treating some forms of cancer, or as adjuncts in fertility programs.

Agonists like goserelin, histrelin, leuprolide, and nafarelin are analogues of GnRH. They decrease production of sex hormones. They are used as treatment for precocious puberty, endometriosis, and advanced prostate cancer.

Antagonists of GnRH like degarelix and ganirelix are used as treatment for advanced prostate cancer and inhibition of premature LH surge in women undergoing controlled ovarian stimulation for fertility.

Here are some important aspects to remember for indication of hypothalamic agents in different age groups:

Children

Monitor closely for adverse effects associated with changes in overall endocrine function, particularly growth and development and metabolism.

Standard part of treatment plan should include periodic radiograph of long bones and monitoring of blood sugar and electrolytes.

Interactions

Drug interactions of hypothalamic agents are related to the specific hormones that the drug is affecting. They will be discussed in detail as each agents for specific hormones will be covered in this study guide.

Nursing Considerations

The specific nursing care of patient who is receiving hypothalamic releasing factor is related to the hormone(s) that the drug is affecting. This will be discussed further as each drugs affecting certain hormones will be covered in this study guide.

Practice Quiz: Hypothalamic Agents

Here are some practice questions for this study guide:

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Practice Quiz: Hypothalamic Agents

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Your answers are highlighted below.

Question 1

All of these drugs can decrease the production of sex hormones, except:

A

goserelin

B

histrelin

C

degarelix

D

tesamorelin

Question 1 Explanation:

Options A, B, and D are all hypothalamic agonists and can, therefore, decrease the production of sex hormones. Agonists inhibit pituitary gonadotropin secretion, with a resultant drop in the production of sex hormones.

Question 2

Which of the following health history data will alert the nurse to question the use of hypothalamic agents in a short-term therapy?

A

history of hepatic lobe transplant three years ago

B

a mother who practices mixed feeding to her newborn baby

C

a chest x-ray suggestive of pneumonia

D

fever probably caused by post-surgical wound infection

Question 2 Explanation:

Hypothalamic agents should be cautioned in lactating mothers because of potential adverse effects to the neonate. All other options are not contraindicated.

Question 3

Knowing hypothalamic agonists’ effect to the sex hormones, which of the following medical conditions can they be used?

A

infertility

B

endometriosis

C

precocious puberty

D

Both B and C

Question 3 Explanation:

Agonists can decrease the production of sex hormones. Medical conditions like endometriosis and precocious puberty are characterized by increased sex hormones. Infertility will best benefit from hypothalamic antagonists.

Question 4

This drug decreases the abdominal fat in HIV-infected patients with lipodystrophy.

A

tesamorelin

B

histrelin

C

leuprolide

D

nafarelin

Question 4 Explanation:

It does this through stimulating the lipolytic effect of growth hormones.

Question 5

Which of the following should be monitored closely in patients receiving hypothalamic agents?

A

serum sodium and potassium levels

B

blood sugar level

C

all of the above

D

none of the above

Question 5 Explanation:

In patients receiving hypothalamic agents, the nurse should monitor closely for adverse effects associated with changes in overall endocrine function, particularly growth and development and metabolism. Other aspects to be monitored include periodic radiograph of long bones, hydration, and nutrition.

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Practice Quiz: Hypothalamic Agents

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Congratulations - you have completed Practice Quiz: Hypothalamic Agents.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Question 1

All of these drugs can decrease the production of sex hormones, except:

A

goserelin

B

histrelin

C

degarelix

D

tesamorelin

Question 1 Explanation:

Options A, B, and D are all hypothalamic agonists and can, therefore, decrease the production of sex hormones. Agonists inhibit pituitary gonadotropin secretion, with a resultant drop in the production of sex hormones.

Question 2

Which of the following health history data will alert the nurse to question the use of hypothalamic agents in a short-term therapy?

A

history of hepatic lobe transplant three years ago

B

a mother who practices mixed feeding to her newborn baby

C

a chest x-ray suggestive of pneumonia

D

fever probably caused by post-surgical wound infection

Question 2 Explanation:

Hypothalamic agents should be cautioned in lactating mothers because of potential adverse effects to the neonate. All other options are not contraindicated.

Question 3

Knowing hypothalamic agonists’ effect to the sex hormones, which of the following medical conditions can they be used?

A

infertility

B

endometriosis

C

precocious puberty

D

Both B and C

Question 3 Explanation:

Agonists can decrease the production of sex hormones. Medical conditions like endometriosis and precocious puberty are characterized by increased sex hormones. Infertility will best benefit from hypothalamic antagonists.

Question 4

This drug decreases the abdominal fat in HIV-infected patients with lipodystrophy.

A

tesamorelin

B

histrelin

C

leuprolide

D

nafarelin

Question 4 Explanation:

It does this through stimulating the lipolytic effect of growth hormones.

Question 5

Which of the following should be monitored closely in patients receiving hypothalamic agents?

A

serum sodium and potassium levels

B

blood sugar level

C

all of the above

D

none of the above

Question 5 Explanation:

In patients receiving hypothalamic agents, the nurse should monitor closely for adverse effects associated with changes in overall endocrine function, particularly growth and development and metabolism. Other aspects to be monitored include periodic radiograph of long bones, hydration, and nutrition.

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Text Mode:All questions and answers are given on a single page for reading and answering at your own pace. Be sure to grab a pen and paper to write down your answers.

1. All of these drugs can decrease the production of sex hormones, except:

A. goserelin
B. histrelin
C. degarelix
D. tesamorelin

1. Answer: C. degarelix

Options A, B, and D are all hypothalamic agonists and can, therefore, decrease the production of sex hormones. Agonists inhibit pituitary gonadotropin secretion, with a resultant drop in the production of sex hormones.

2. Which of the following health historydata will alert the nurse to question the use of hypothalamic agents in a short-term therapy?

A. history of hepatic lobe transplant three years ago
B. a mother who practices mixed feeding to her newborn baby
C. a chest x-ray suggestive of pneumonia
D. fever probably caused by post-surgical wound infection

2. Answer: B. a mother who practices mixed feeding to her newborn baby

Hypothalamic agents should be cautioned in lactating mothers because of potential adverse effects to the neonate. All other options are not contraindicated.

3. Knowing hypothalamic agonists’ effect to the sex hormones, which of the following medical conditions can they be used?

Agonists can decrease the production of sex hormones. Medical conditions like endometriosis and precocious puberty are characterized by increased sex hormones. Infertility will best benefit from hypothalamic antagonists.

4. This drug decreases the abdominal fat in HIV-infected patients with lipodystrophy.

A. tesamorelin
B. histrelin
C. leuprolide
D. nafarelin

4. Answer: A. tesamorelin

It does this through stimulating the lipolytic effect of growth hormones.

5. Which of the following should be monitored closely in patients receiving hypothalamic agents?

A. serum sodium and potassium levels
B. blood sugar level
C. all of the above
D. none of the above

5. Answer: C. all of the above

In patients receiving hypothalamic agents, the nurse should monitor closely for adverse effects associated with changes in overall endocrine function, particularly growth and development and metabolism. Other aspects to be monitored include periodic radiograph of long bones, hydration, and nutrition.